OTE Safety Observation

Observer*

Employee's Name*

Multiple Employees

Multiple Employees

Employee 2

Employee 3

Employee Email (Optional)

Fill out to automatically send copy of observation to employee.

Date*

Time*

:

Rule/Task Observed*

219 Rule G Observation

Questions to Ask

• How could you get hurt? • What kind of injury? • How could you prevent it? • What if the unexpected happens? • Can you tell me about your job? • What could go wrong? • How serious? • Who else could be affected? • What worried me when I first saw you? • Why do you think I stopped you? • How can the job be done more safely? • What do you do in an emergency? •

Observations

Reactions of Crew

Changing Positions
Rearranging Their Job
Adjust or Add PPE
No Change of Position

Reactions of Crew Notes

Positions of Crew

Positions of Crew Notes

Personal Protective Equipment

Head, Face, Ears, Eyes
Hands and Feet
Respiratory
Workwear
Harness
Welding hood/respiration/ventilation

Personal Protective Equipment Notes

Tools and Equipment

Right for the Job
Used Correctly
Safe Condition
Storage
Maintained
Guarded + Isolation

Tools and Equipment Notes

Procedure (Standards)

Adequate
Established
Maintained
No Procedure Established

Procedure (Standards) Notes

Orderly and Tidy

Standards Established
Understood
Maintained
Housekeeping
Slip,Trip Hazards

Orderly and Tidy Notes

Environmental

Procedures Understood
Waste Streams (slag, sparks, chemicals, oil) Solid Waste
Spills
Use of Chemicals
Spill Containment
Exhaust/Ventilation

Environmental Notes

Vehicle

Access (Three Points of Contact)
Outriggers Position
Access Egress Routes
Vehicle Movement
Seat Belts
Driving
Loaded Correctly
Backing/Spotting

Vehicle Notes

Fire

Equipment
Training
PPE
Spark Shields
Welding/Grinding/Cutting protocols

Fire Notes

Rules Compliant*

Comments and Recommendations

Additional Notes:

Employee Comments:

Observer Signature*

Name*

First Last

Employee's Signature*

Name*

First Last

Employee 2 Signature

Employee 2 Name

First Last

Employee 3 Signature

Employee 3 Name

First Last